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Li T, Dong L, Zhang D, Han J, Dai M, Guo J, Xu Q, Wang W, Han X, Lin C. Evaluating the surgical and oncological outcomes of hepatic artery variations in minimally invasive pancreaticoduodenectomy: insights from 2023 data at a high-volume pancreatic center. World J Surg Oncol 2025; 23:44. [PMID: 39920789 PMCID: PMC11804064 DOI: 10.1186/s12957-025-03704-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 02/04/2025] [Indexed: 02/09/2025] Open
Abstract
BACKGROUND Minimally invasive pancreaticoduodenectomy (MIPD) has seen increased adoption due to advancements in surgical techniques and technology. However, the impact of hepatic artery variations (HAV) and clinically relevant HAV (CR-HAV) on MIPD outcomes remains under-investigated. This study aims to explore the differences in surgical and oncological outcomes of MIPD with or without HAV and CR-HAV. METHODS We enrolled 267 consecutive patients who underwent MIPD at Peking Union Medical College Hospital between January and December 2023. HAV was identified preoperatively through enhanced abdominal CT and three-dimensional reconstruction, and classified according to the Michels and Hiatt systems. Clinically relevant hepatic artery variations (CR-HAV) were defined based on their potential impact on the surgical approach. We collected and analyzed perioperative data and oncological outcomes between patients with and without HAV and CR-HAV. Propensity score matching (PSM) was used to minimize baseline confounding. Survival analysis was performed using the Kaplan-Meier method with log-rank tests. RESULTS HAV was identified in 26.1% of patients, and CR-HAV in 18.9%. The median operation time was significantly longer in HAV (+) group compared to HAV (-) group (6.72 vs. 5.80 h, p = 0.013). No significant differences were found between HAV/CR-HAV (+) and (-) groups regarding intraoperative blood loss, conversion to laparotomy, postoperative complications, surgical mortality, length of stay, re-operation, and re-admission. Kaplan-Meier survival analysis showed no significant differences in overall survival or progression-free survival between HAV/CR-HAV (+) and (-) groups in the malignant cohort. CONCLUSION HAV and CR-HAV do not significantly impact overall or progression-free survival in patients undergoing MIPD. While HAV is associated with longer operation times, other perioperative and oncological outcomes remain comparable between HAV/CR-HAV (+) and (-) groups.
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Affiliation(s)
- Tianyu Li
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liangbo Dong
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongming Zhang
- Department of General Surgery, Baotou Central Hospital, Baotou, Inner Mongolia, China
| | - Jiashu Han
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Menghua Dai
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junchao Guo
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiang Xu
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weibin Wang
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Xianlin Han
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Chen Lin
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Yu AT, Sarfaty E, Pahlkotter M, Cohen NA. Open Gastric Surgery for Gastric Cancer. Surg Clin North Am 2025; 105:1-13. [PMID: 39523066 DOI: 10.1016/j.suc.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
Gastric cancer is a leading cause of cancer and cancer-related mortality worldwide, especially in East Asia. It is often diagnosed at an advanced stage, which carries a poor prognosis. Patients with advanced gastric cancer typically receive systemic therapy and best supportive care. For patients with locally advanced gastric cancer, a combination of systemic therapy and surgical resection is recommended, while surgical resection-alone is recommended for patients with early-stage localized tumors. Surgical resection, including total gastrectomy, distal gastrectomy, and proximal gastrectomy, is recommended for resection of localized tumors based on tumor location. Herein, the authors provide an overview of open gastrectomy resection and reconstruction techniques.
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Affiliation(s)
- Allen T Yu
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elad Sarfaty
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maranda Pahlkotter
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Noah A Cohen
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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3
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Tang R, Wu G, Tong X, Yu L, Li A, Lin J, Xu G, Lu Q. A novel proceduralized donor liver back-table preparation technique minimizes hemorrhage following liver implantation in orthotropic liver transplantation. Front Surg 2024; 11:1356142. [PMID: 39726765 PMCID: PMC11669602 DOI: 10.3389/fsurg.2024.1356142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 11/18/2024] [Indexed: 12/28/2024] Open
Abstract
Background Intraoperative hemorrhage is one of the major complications of orthotopic liver transplantation (OLTX) and is mainly caused by technical difficulties of the surgical procedure besides primary liver diseases. The present study aimed to evaluate the feasibility and clinical effects of a novel proceduralized donor liver back-table preparation (DLBTP) technique for use in OLTX. Methods This retrospective study was conducted between January 2018 and June 2020 based on patients who had undergone OLTX. All livers transplanted using the reported back-table procedures were defined as the control group A (n = 43), while those prepared using our new procedure as the experimental group B (n = 160). The first-hand surgical experience of transplant surgeons was surveyed in a post hoc comparative analysis. Results DLBTP time was significantly longer and the probability of low-quality hepatic artery skeletonization was lower in group B compared to group A patients. Compared to group A, the time for hemorrhage control was shorter [P < 0.05, 0.3 h (range, 0.17-0.58 h)], and the degree of blood loss was less [P < 0.05, 60 ml (range, 30-240 ml)] in group B. Major bleeding sites were soft tissue of the hepatic hilum and the wall of the inferior vena cava. Due to trimmed soft tissue in the first porta hepatis region, there was less blood oozing, making it easier to stem the bleeding and construct anastomosis. Conclusion Although the procedural DLBTP for OLTX was time-consuming, the new procedure significantly reduced the degree of hemorrhage and the time required to control bleeding.
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Affiliation(s)
| | | | | | | | | | | | | | - Qian Lu
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Institute for Precision Medicine, Tsinghua University, Beijing, China
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Mohnasky M, Pisanie LD, Mizero J, Gad S, Shahbazian H, Villalobos A, Kokabi N. A rare case of replaced right hepatic artery with direct aortic origin described angiographically during trans-arterial radioembolization. Radiol Case Rep 2024; 19:5665-5669. [PMID: 39308614 PMCID: PMC11414547 DOI: 10.1016/j.radcr.2024.08.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 08/17/2024] [Indexed: 09/25/2024] Open
Abstract
Normal hepatic arterial anatomy consists of the right hepatic artery and left hepatic artery branching from the common hepatic artery. Despite this being the most common configuration, many variations have been described. Here, we present a rare variant of hepatic arterial anatomy- a replaced right hepatic artery with direct aortic origin. Additionally, the patient was found to have a dorsal pancreatic artery originating from the replaced right hepatic artery This was angiographically identified during mapping for transarterial radioembolization for hepatocellular carcinoma. The unique anatomy in this case and the effect it had on transarterial radioembolization planning described herein demonstrates the necessity of understanding variant hepatic arterial anatomy in endovascular hepatic interventions.
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Affiliation(s)
- Michael Mohnasky
- University of North Carolina at Chapel Hill, School of Medicine, 321 S Columbia St, Chapel Hill, NC, USA
| | - Lourens Du Pisanie
- Department of Radiology, University of North Carolina, 101 Manning Dr, Chapel Hill, NC, USA
| | - Jocelyn Mizero
- University of Ghana, School of Medicine, Guggisberg Ave, Accra, Ghana
| | - Sandra Gad
- University of Ghana, School of Medicine, Guggisberg Ave, Accra, Ghana
- Saint George's University, School of Medicine, University Centre Grenada, West Indies, Grenada
| | - Haneyeh Shahbazian
- Department of Radiology, University of North Carolina, 101 Manning Dr, Chapel Hill, NC, USA
| | - Alex Villalobos
- University of Ghana, School of Medicine, Guggisberg Ave, Accra, Ghana
| | - Nima Kokabi
- Department of Radiology, University of North Carolina, 101 Manning Dr, Chapel Hill, NC, USA
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van den Bemd BAT, Puijk RS, Keijzers H, van den Tol PM, Meijerink MR. Mathematical 3D Liver Model for Surgical versus Ablative Therapy Treatment Planning for Colorectal Liver Metastases: Recommendations from the COLLISION and COLDFIRE Trial Expert Panels. Radiol Imaging Cancer 2024; 6:e240068. [PMID: 39400233 PMCID: PMC11615634 DOI: 10.1148/rycan.240068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/24/2024] [Accepted: 09/05/2024] [Indexed: 10/15/2024]
Abstract
Purpose To further define anatomic criteria for resection and ablation using an expert panel-based three-dimensional liver model to objectively predict local treatment recommendations for colorectal liver metastases (CRLM). Materials and Methods This study analyzed data from participants with small CRLM (≤3 cm) considered suitable for resection, thermal ablation, or irreversible electroporation (IRE), according to a multidisciplinary expert panel, who were included in two prospective multicenter trials (COLLISION [NCT03088150] and COLDFIRE-2 [NCT02082782]) between August 2017 and June 2022. Ten randomly selected participants were used to standardize the model's Couinaud segments. CRLM coordinates were measured and plotted in the model as color-coded lesions according to the treatment recommendations. Statistical validation was achieved through leave-one-out cross-validation. Results A total of 611 CRLM in 202 participants (mean age, 63 [range, 29-87] years; 138 male and 64 female) were included. Superficially located CRLM were considered suitable for resection, whereas more deep-seated CRLM were preferably ablated, with the transition zone at a subsurface depth of 3 cm. Ninety-three percent (25 of 27) of perihilar CRLM treated with IRE were at least partially located within 1 cm from the portal triad. Use of the model correctly predicted the preferred treatment in 313 of 424 CRLM (73.8%). Conclusion The results suggest that CRLM can be defined as superficial (preferably resected) and deep-seated (preferably ablated) if the tumor center is within versus beyond 3 cm from the liver surface, respectively, and as perihilar if the tumor margins extend to within 1 cm from the portal triad. Keywords: Ablation Techniques, CT, MRI, Liver, Abdomen/GI, Metastases, Oncology Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Bente A. T. van den Bemd
- From the Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the
Netherlands (B.A.T.v.d.B., R.S.P., M.R.M.); Cancer Center Amsterdam, Amsterdam,
the Netherlands (B.A.T.v.d.B., R.S.P., M.R.M.); Department of Surgical Oncology,
OLVG Hospital, Oost, Amsterdam, the Netherlands (B.A.T.v.d.B.); Department of
Radiology and Nuclear Medicine, OLVG Hospital, Oost, Amsterdam, the Netherlands
(R.S.P.), Department of Medical Physics and Radiation Protection, Haaglanden MC,
The Hague, the Netherlands (H. Keijzers); and Department of Surgical Oncology,
Medical Center Leeuwarden, Leeuwarden, the Netherlands (P.M.v.d.T.)
| | - Robbert S. Puijk
- From the Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the
Netherlands (B.A.T.v.d.B., R.S.P., M.R.M.); Cancer Center Amsterdam, Amsterdam,
the Netherlands (B.A.T.v.d.B., R.S.P., M.R.M.); Department of Surgical Oncology,
OLVG Hospital, Oost, Amsterdam, the Netherlands (B.A.T.v.d.B.); Department of
Radiology and Nuclear Medicine, OLVG Hospital, Oost, Amsterdam, the Netherlands
(R.S.P.), Department of Medical Physics and Radiation Protection, Haaglanden MC,
The Hague, the Netherlands (H. Keijzers); and Department of Surgical Oncology,
Medical Center Leeuwarden, Leeuwarden, the Netherlands (P.M.v.d.T.)
| | - Han Keijzers
- From the Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the
Netherlands (B.A.T.v.d.B., R.S.P., M.R.M.); Cancer Center Amsterdam, Amsterdam,
the Netherlands (B.A.T.v.d.B., R.S.P., M.R.M.); Department of Surgical Oncology,
OLVG Hospital, Oost, Amsterdam, the Netherlands (B.A.T.v.d.B.); Department of
Radiology and Nuclear Medicine, OLVG Hospital, Oost, Amsterdam, the Netherlands
(R.S.P.), Department of Medical Physics and Radiation Protection, Haaglanden MC,
The Hague, the Netherlands (H. Keijzers); and Department of Surgical Oncology,
Medical Center Leeuwarden, Leeuwarden, the Netherlands (P.M.v.d.T.)
| | - Petrousjka M. van den Tol
- From the Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the
Netherlands (B.A.T.v.d.B., R.S.P., M.R.M.); Cancer Center Amsterdam, Amsterdam,
the Netherlands (B.A.T.v.d.B., R.S.P., M.R.M.); Department of Surgical Oncology,
OLVG Hospital, Oost, Amsterdam, the Netherlands (B.A.T.v.d.B.); Department of
Radiology and Nuclear Medicine, OLVG Hospital, Oost, Amsterdam, the Netherlands
(R.S.P.), Department of Medical Physics and Radiation Protection, Haaglanden MC,
The Hague, the Netherlands (H. Keijzers); and Department of Surgical Oncology,
Medical Center Leeuwarden, Leeuwarden, the Netherlands (P.M.v.d.T.)
| | - Martijn R. Meijerink
- From the Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the
Netherlands (B.A.T.v.d.B., R.S.P., M.R.M.); Cancer Center Amsterdam, Amsterdam,
the Netherlands (B.A.T.v.d.B., R.S.P., M.R.M.); Department of Surgical Oncology,
OLVG Hospital, Oost, Amsterdam, the Netherlands (B.A.T.v.d.B.); Department of
Radiology and Nuclear Medicine, OLVG Hospital, Oost, Amsterdam, the Netherlands
(R.S.P.), Department of Medical Physics and Radiation Protection, Haaglanden MC,
The Hague, the Netherlands (H. Keijzers); and Department of Surgical Oncology,
Medical Center Leeuwarden, Leeuwarden, the Netherlands (P.M.v.d.T.)
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Orgera G, Ubaldi N, Rossi T, Rossi M, Krokidis M. Gastric band removal: mind the arterial anastomoses! Clin J Gastroenterol 2024; 17:834-838. [PMID: 39008231 DOI: 10.1007/s12328-024-02018-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/09/2024] [Indexed: 07/16/2024]
Abstract
Bariatric surgery may sometimes be challenging and may lead to severe complications. Surgical re-intervention in such cases is not the preferred option due to co-morbidities. When severe bleeding occurs, embolization of the lacerated vessels is the preferred minimal invasive management option and needs to be available if possible. We would like to report a case of young patient who underwent severe bleeding after migration of a gastric band. The patient was successfully embolized and the band was removed. However, on the second post-operative day, the patient complained again for acute abdominal pain and turned haemodynamically unstable. Fresh blood was aspirated from the surgical drain. A new emergency CT scan was performed and a new large pseudoaneurysm was revealed taking origin from the left gastric artery. The second bleeding occurred due to an anastomotic communication and was also successfully embolized. The main take home messages are that bariatric surgery may lead to several complications including bleeding, gastric band may cause vessel erosion but also offer a tamponade effect, endovascular embolization of the lacerated vessels is the preferred management and pseudoaneurysms arising in hepato-splenic or gastroduodenal arteries should be treated with the sandwich embolization technique.
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Affiliation(s)
- Gianluigi Orgera
- Department of Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Nicolò Ubaldi
- Department of Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Tommaso Rossi
- Department of Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Michele Rossi
- Department of Radiology, Sant'Andrea University Hospital La Sapienza, Rome, Italy
| | - Miltiadis Krokidis
- 1st Department of Radiology, Areteion University Hospital, Medical School, National and Kapodistrian University of Athens, 76 Vas. Sophias Av, 11528, Athens, Greece.
- Department of Diagnostic, Interventional and Pediatric Radiology (DIPR), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Gupta S, Vemulakonda SHP, Punati S, Tripathy TP, Patel RK, Dutta T, Pattnaik B. Replaced common hepatic artery from left gastric artery during pancreatico-duodenectomy; insight holds the key. ANZ J Surg 2024; 94:1871-1872. [PMID: 38923808 DOI: 10.1111/ans.19145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 06/07/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Sunita Gupta
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Spruha Punati
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Tara Prasad Tripathy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Ranjan Kumar Patel
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Tanmay Dutta
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Bramhadatta Pattnaik
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, India
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Verrept S, Van Den Eynde W, De Bruecker Y. Hepatic Artery Aneurysm-A Rare Cause of Cholestasis. J Belg Soc Radiol 2024; 108:85. [PMID: 39345985 PMCID: PMC11428659 DOI: 10.5334/jbsr.3751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 09/12/2024] [Indexed: 10/01/2024] Open
Abstract
Hepatic artery aneurysms (HAAs) are rare vascular malformations that can arise from atherosclerosis, trauma, or iatrogenic injury. HAAs can be symptomatic and lead to serious complications. We present the case of a patient with painless jaundice caused by obstruction of the distal common bile duct by a HAA on a replaced right hepatic artery. This was further complicated with cholangitis. After endovascular stenting of the aneurysm, cholestasis decreased. Learning point: Hepatic artery aneurysms can cause common bile duct obstruction resulting in cholestasis.
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Affiliation(s)
- Sam Verrept
- Radiology department Imelda Hospital, Bonheiden, Belgium
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Ueda H, Takahashi H, Akita H, Tomimaru Y, Kobayashi S, Kubo M, Mukai Y, Toshiyama R, Sasaki K, Hasegawa S, Iwagami Y, Sakai K, Yamada D, Noda T, Asaoka T, Wada H, Gotoh K, Doki Y, Eguchi H. Prognostic impact of aberrant right hepatic artery involvement in patients with pancreatic cancer: A multicenter retrospective cohort study. J Surg Oncol 2024; 130:504-515. [PMID: 39099198 DOI: 10.1002/jso.27792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/13/2024] [Accepted: 07/20/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND AND OBJECTIVES This study aimed to evaluate the prognostic value of aberrant right hepatic artery (A-RHA) involvement in patients with pancreatic cancer (PC). METHODS This study enrolled 474 patients who underwent upfront pancreatectomy or neoadjuvant treatment for resectable (R) or borderline resectable (BR) PC from four institutions. The patients were divided into three groups: A-RHA involvement group (n = 12), patients who had sole A-RHA involvement without major arterial involvement; BR-A group (n = 104), patients who had major arterial involvement; R/BR-PV group (n = 358), others. RESULTS All patients in the A-RHA involvement group underwent margin-negative resection. The median overall survival of the entire cohort in the A-RHA involvement, R/BR-PV, and BR-A groups was 41.2, 33.5, and 25.2 months, respectively. Although survival in the R/BR-PV group was significantly more favorable than that in the BR-A group (p = 0.0003), no significant difference was observed between the A-RHA involvement group and the R/BR-PV (p = 0.7332) and BR-A (p = 0.1485) groups. CONCLUSIONS The prognosis of patients with PC and sole A-RHA involvement was comparable to that of patients with R/BR-PV.
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Affiliation(s)
- Hiroki Ueda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hidenori Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hirofumi Akita
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yoshito Tomimaru
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Masahiko Kubo
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yousuke Mukai
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Reishi Toshiyama
- Department of Surgery, NHO Osaka National Hospital, Osaka, Japan
| | - Kazuki Sasaki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Shinichiro Hasegawa
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yoshifumi Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Kenji Sakai
- Department of Surgery, NHO Osaka National Hospital, Osaka, Japan
| | - Daisaku Yamada
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takehiro Noda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tadafumi Asaoka
- Department of Gastroenterological Surgery, Osaka Police Hospital, Osaka, Japan
| | - Hiroshi Wada
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Kunihito Gotoh
- Department of Surgery, NHO Osaka National Hospital, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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Yağdıran B, Karakaya E, Şafak A, Çubuk HS, Mamedova D, Haberal KM, Coşkun M, Haberal M. Are the Classifications Used to Determine Hepatic Artery Variations in Liver Donors Sufficient? EXP CLIN TRANSPLANT 2024; 22:691-697. [PMID: 39431837 DOI: 10.6002/ect.2024.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2024]
Abstract
OBJECTIVES Liver transplant from a living donor is a more challenging procedure than liver transplant from a deceased donor, given that optimal blood supply to both the remaining liver segment in the donor and the graft must be maintained to ensure successful donor hepatectomy. During surgical planning, in addition to calculation of volumetric data with multidetector tomography, the anatomy of the hepatic artery, portal vein, and hepatic vein must also be meticulously determined, with the most commonly used clas-sification methods for hepatic artery variations being the Michels and Hiatt classifications. Although these classification methods can accurately group most patients, we often encounter a large number of patients who cannot be grouped or who exhibit other variations that accompany the defined group. MATERIALS AND METHODS We examined the hepatic artery computed tomography angiography tests taken before the operations of 290 living liver donors performed at our hospital between 2012 and 2023 and grouped the hepatic artery variations according to the Michels and Hiatt classifications. We also identified and classified cases that could not be classified into the groups of either classification method. RESULTS We identified 144 patients (62.61%) who fit the Michels classification. Eighty-six patients (37.39%) did not conform to the groups defined in either classification system. We identified 173 patients (75.22%) patients who fit the Hiatt classification, and 57 (24.78%) who did not. Notable variations included those in the medial and lateral branches of the left hepatic artery, those in the origin of the right hepatic artery, and the trifurcation of the common hepatic artery into the gastroduodenal artery, right hepatic artery, and left hepatic artery. CONCLUSIONS The Michels and Hiatt classification systems are not sufficient for determining hepatic artery variations in many patients. A more comprehensive classification system that includes segmental arteries is needed.
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Affiliation(s)
- Burak Yağdıran
- >From the Department of Radiology, Baskent University Faculty of Medicine, Ankara, Turkey
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Duddu Y, Bhingardeo AV, Darna S, Ganti S, Chandrupatla M. Unique Hepatic Arterial Pattern Associated With the Presence of Accessory Proper Hepatic Artery and Middle Hepatic Artery. Cureus 2024; 16:e65932. [PMID: 39221320 PMCID: PMC11365703 DOI: 10.7759/cureus.65932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2024] [Indexed: 09/04/2024] Open
Abstract
Vascular variations of the coeliac trunk are relatively common, with documented occurrences including trifurcation of the common hepatic artery (CHA) and the presence of accessory and replaced hepatic arteries. This case report describes a novel variation wherein the CHA trifurcates into the proper hepatic artery (PHA), gastroduodenal artery, and accessory PHA (APHA). This particular trifurcation pattern has not been previously recorded. The APHA further branches into two arteries that supply the right lobe of the liver. Additionally, a middle hepatic artery (MHA), originating from the PHA, was identified alongside the right and left hepatic arteries. The MHA serves as a hilar artery that drains segment IV of the liver. This anatomical variant does not conform to any existing coeliac trunk classifications. Understanding this unique arterial pattern is crucial for liver transplantation, as well as procedures involving the pancreas, duodenum, and gallbladder, and for interventional techniques such as transcatheter arterial chemoembolization and transarterial radionuclide therapy.
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Affiliation(s)
- Yashwanth Duddu
- Anatomy, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Alka V Bhingardeo
- Anatomy, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Srija Darna
- Anatomy, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
| | - Savithru Ganti
- Anatomy, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND
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Bissinde E, Brustia R, Savier E. Early bifurcation of the common hepatic artery: A pitfall that should be known and recognized. J Visc Surg 2024; 161:250-254. [PMID: 38971630 DOI: 10.1016/j.jviscsurg.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2024]
Abstract
Early bifurcation of the common hepatic artery (EBCHA) is a rare anatomical variation (1%), that is often overlooked but can lead to accidental ligation of the right branch of the hepatic artery with consequent arterial ischemia of the right liver and potentially very serious complications during pancreaticoduodenectomy, partial hepatectomy, or liver harvesting for transplantation. It may be difficult to diagnose EBCHA using transverse imaging sections. However, on standard CT sections with intravenous contrast injection, three warning signs should allow the image reader to suspect it: presence of two hepatic arteries to the right of the celiac trunk, presence of a retro-portal hepatic artery, and absence of a right hepatic artery arising from the superior mesenteric artery. Analysis of the CT with reconstruction then allows for definitive diagnosis and limits the risk of accidental arterial injury or ligation.
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Affiliation(s)
- Evariste Bissinde
- Department of General and Digestive Surgery, Bogodogo University Hospital, 14BP 371 Ouagadougou, Burkina Faso
| | - Raffaele Brustia
- Department of Digestive and Hepato-Pancreatic-Biliary Surgery, Hôpital Henri-Mondor, AP-HP, Paris Est Créteil University, UPEC, Créteil, France; Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Inserm U955, Créteil, France; Public Assistance-Paris Hospitals, Créteil, France
| | - Eric Savier
- Department of Digestive and Hepato-Bilio-Pancreatic Surgery, Liver Transplantation, CHU Pitié-Salpêtriere, Public Assistance-Paris Hospitals (AP-HP), Sorbonne University, Paris, France; Saint-Antoine Research Centre (CRSA), Institute of Cardiometabolism and Nutrition (ICAN), Inserm, Sorbonne University, Paris, France.
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Yu HH, Wang SE, Shyr BS, Chen SC, Shyr YM, Shyr BU. Impact of hepatic artery variation on surgical and oncological outcomes in robotic pancreaticoduodenectomy. Surg Endosc 2024; 38:3728-3737. [PMID: 38780631 DOI: 10.1007/s00464-024-10887-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND In patients with hepatic artery variation (HAV), feasibility and justification of robotic pancreatoduodenectomy (RPD) for periampullary lesions have been not been well established. METHODS A total of 600 patients with periampullary lesions receiving RPD or open pancreaticoduodenectomy (OPD) were identified from our prospectively collected computer database. Surgical outcomes, oncological radicality, and survival outcomes after RPD in HAV ( +) and (-) patients were compared. RESULTS The incidence of HAV was 16%, including 12.7% in patients with RPD and 23.0% in those with OPD. In the HAV ( +) group, vascular injury rate had no statistical difference between the RPD (3.7%) and OPD (9.1%) patients, P = 0.404. Among the RPD patients, those with HAV ( +) had longer operation time (8.5 ± 2.5 vs. 7.7 ± 2.0 h, P = 0.013) and higher vascular injury (3.8% vs. 0.6%, P = 0.024) when compared with the HAV (-) patients. There was no significant difference between the HAV ( +) and (-) patients with RPD regarding blood loss, open conversion, vascular resection, and surgical mortality and morbidity. There was no survival difference between the HAV ( +) and (-) patients with pancreatic head adenocarcinoma after RPD. There was no survival difference between RPD and OPD in the HAV ( +) group. CONCLUSIONS When compared with OPD, RPD is feasible and justifiable without increasing vascular injury rate for patients with HAV ( +). Hepatic artery variation has no negative impact on surgical, oncological, and survival outcomes following an RPD, if it is accurately identified pre-operatively and appropriately managed intraoperatively.
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Affiliation(s)
- Hsuan-Hsuan Yu
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shin-E Wang
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Bor-Shiuan Shyr
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shih-Chin Chen
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yi-Ming Shyr
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Bor-Uei Shyr
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
- Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
- National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, and National Yang Ming Chiao Tung University, 10 Floor 201 Section 2 Shipai Road, Taipei, 112, Taiwan, ROC.
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Kim DS, Yoon YI, Kim BK, Choudhury A, Kulkarni A, Park JY, Kim J, Sinn DH, Joo DJ, Choi Y, Lee JH, Choi HJ, Yoon KT, Yim SY, Park CS, Kim DG, Lee HW, Choi WM, Chon YE, Kang WH, Rhu J, Lee JG, Cho Y, Sung PS, Lee HA, Kim JH, Bae SH, Yang JM, Suh KS, Al Mahtab M, Tan SS, Abbas Z, Shresta A, Alam S, Arora A, Kumar A, Rathi P, Bhavani R, Panackel C, Lee KC, Li J, Yu ML, George J, Tanwandee T, Hsieh SY, Yong CC, Rela M, Lin HC, Omata M, Sarin SK. Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation. Hepatol Int 2024; 18:299-383. [PMID: 38416312 DOI: 10.1007/s12072-023-10629-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/18/2023] [Indexed: 02/29/2024]
Abstract
Liver transplantation is a highly complex and challenging field of clinical practice. Although it was originally developed in western countries, it has been further advanced in Asian countries through the use of living donor liver transplantation. This method of transplantation is the only available option in many countries in the Asia-Pacific region due to the lack of deceased organ donation. As a result of this clinical situation, there is a growing need for guidelines that are specific to the Asia-Pacific region. These guidelines provide comprehensive recommendations for evidence-based management throughout the entire process of liver transplantation, covering both deceased and living donor liver transplantation. In addition, the development of these guidelines has been a collaborative effort between medical professionals from various countries in the region. This has allowed for the inclusion of diverse perspectives and experiences, leading to a more comprehensive and effective set of guidelines.
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Affiliation(s)
- Dong-Sik Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-In Yoon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jongman Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Jin Joo
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Joong Choi
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Tae Yoon
- Department of Internal Medicine, Pusan National University College of Medicine, Yangsan, Republic of Korea
| | - Sun Young Yim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Cheon-Soo Park
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Deok-Gie Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae Won Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Won-Mook Choi
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Eun Chon
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Woo-Hyoung Kang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Geun Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yuri Cho
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Ilsan, Republic of Korea
| | - Pil Soo Sung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Han Ah Lee
- Department of Internal Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Ji Hoon Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Si Hyun Bae
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Mo Yang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Soek Siam Tan
- Department of Medicine, Hospital Selayang, Batu Caves, Selangor, Malaysia
| | - Zaigham Abbas
- Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Ananta Shresta
- Department of Hepatology, Alka Hospital, Lalitpur, Nepal
| | - Shahinul Alam
- Crescent Gastroliver and General Hospital, Dhaka, Bangladesh
| | - Anil Arora
- Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital New Delhi, New Delhi, India
| | - Ashish Kumar
- Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital New Delhi, New Delhi, India
| | - Pravin Rathi
- TN Medical College and BYL Nair Hospital, Mumbai, India
| | - Ruveena Bhavani
- University of Malaya Medical Centre, Petaling Jaya, Selangor, Malaysia
| | | | - Kuei Chuan Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jun Li
- College of Medicine, Zhejiang University, Hangzhou, China
| | - Ming-Lung Yu
- Department of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | | | | | | | - H C Lin
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Masao Omata
- Department of Gastroenterology, Yamanashi Central Hospital, Yamanashi, Japan
- University of Tokyo, Bunkyo City, Japan
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15
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Alaimo L, Marchese A, Vignola D, Roman D, Conci S, De Bellis M, Pedrazzani C, Campagnaro T, Manzini G, Guglielmi A, Ruzzenente A. The Role of Three-Dimensional Modeling to Improve Comprehension of Liver Anatomy and Tumor Characteristics for Medical Students and Surgical Residents. JOURNAL OF SURGICAL EDUCATION 2024; 81:597-606. [PMID: 38388310 DOI: 10.1016/j.jsurg.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/27/2023] [Accepted: 12/30/2023] [Indexed: 02/24/2024]
Abstract
OBJECTIVE Studying liver anatomy can be challenging for medical students and surgical residents due to its complexity. Three-dimensional visualization technology (3DVT) allows for a clearer and more precise view of liver anatomy. We sought to assess how 3DVT can assist students and surgical residents comprehend liver anatomy. DESIGN Data from 5 patients who underwent liver resection for malignancy at our institution between September 2020 and April 2022 were retrospectively reviewed and selected following consensus among the investigators. Participants were required to complete an online survey to investigate their understanding of tumor characteristics and vascular variations based on patients' computed tomography (CT) and 3DVT. SETTING The study was carried out at the General and Hepato-Biliary Surgery Department of the University of Verona. PARTICIPANTS Among 32 participants, 13 (40.6%) were medical students, and 19 (59.4%) were surgical residents. RESULTS Among 5 patients with intrahepatic lesions, 4 patients (80.0%) had at least 1 vascular variation. Participants identified number and location of lesions more correctly when evaluating the 3DVT (84.6% and 80.9%, respectively) compared with CT scans (61.1% and 64.8%, respectively) (both p ≤ 0.001). The identification of any vascular variations was more challenging using the CT scans, with only 50.6% of correct answers compared with 3DVT (72.2%) (p < 0.001). Compared with CT scans, 3DVT led to a 23.5%, 16.1%, and 21.6% increase in the correct definition of number and location of lesions, and vascular variations, respectively. 3DVT allowed for a decrease of 50.8 seconds (95% CI 23.6-78.0) in the time needed to answer the questions. All participants agreed on the usefulness of 3DVT in hepatobiliary surgery. CONCLUSIONS The 3DVT facilitated a more precise preoperative understanding of liver anatomy, tumor location and characteristics.
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Affiliation(s)
- Laura Alaimo
- Division of General and Hepato-Biliary Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital G.B. Rossi, Verona, Italy
| | - Andrea Marchese
- Division of General and Hepato-Biliary Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital G.B. Rossi, Verona, Italy
| | - Damiano Vignola
- Department of Orthopaedics and Trauma Surgery, University of Verona, Verona, Italy
| | - Diletta Roman
- Division of General and Hepato-Biliary Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital G.B. Rossi, Verona, Italy
| | - Simone Conci
- Division of General and Hepato-Biliary Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital G.B. Rossi, Verona, Italy
| | - Mario De Bellis
- Division of General and Hepato-Biliary Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital G.B. Rossi, Verona, Italy
| | - Corrado Pedrazzani
- Division of General and Hepato-Biliary Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital G.B. Rossi, Verona, Italy
| | - Tommaso Campagnaro
- Division of General and Hepato-Biliary Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital G.B. Rossi, Verona, Italy
| | - Gessica Manzini
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital G.B. Rossi, Verona, Italy
| | - Alfredo Guglielmi
- Division of General and Hepato-Biliary Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital G.B. Rossi, Verona, Italy
| | - Andrea Ruzzenente
- Division of General and Hepato-Biliary Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital G.B. Rossi, Verona, Italy.
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Keskin N, Bamac B, Cakir O, Colak T, Barut C. Superior mesenteric artery revisited using magnetic resonance angiography. Surg Radiol Anat 2024; 46:523-534. [PMID: 38376526 DOI: 10.1007/s00276-024-03323-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/12/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE We aimed to examine the superior mesenteric artery in detail by magnetic resonance angiography to provide an alternative to other imaging methods, to reduce the exposure time of patients and physicians to X-rays and the time spent in catheter angiography, to determine the variations, positions, and locations of the celiac trunk, and to provide detailed information for surgeons and interventional radiologists using this method. METHODS The procedures were approved by the Kocaeli University Medical School Non-Interventional Clinical Research Ethics Committee (10.04.2023, approval number: 2021/51). MR angiography images of 185 patients with abdominal imaging in PACS (Picture Archiving Communication Systems) were retrospectively registered. The level of origin of the superior mesenteric artery according to the vertebral column, angle of origin, distance between the superior mesenteric artery and branches of the abdominal aorta, and branching pattern of the superior mesenteric artery were evaluated. Parameters were evaluated according to gender and age using SPSS version 25. RESULTS The distance between superior mesenteric artery-inferior mesenteric artery and superior mesenteric artery-aortic bifurcation in males was higher than in females, and the difference was statistically significant. In females and the whole study group, a low, positive and significant relationship was found between age and superior mesenteric artery-sagittal angle. The most common origin site for the superior mesenteric artery, according to the vertebral column was found to be at L1 middle for males and L1 upper for females. The most common superior mesenteric artery branching pattern was classical type in both genders. CONCLUSION Individual evaluation of the superior mesenteric artery could reduce the risks during surgical interventions, considering the relationship of the superior mesenteric artery, especially with distally located vessels, and the gender differences for the angle of origin. Furthermore, considering that interventional radiologists choose the catheter according to the angle of origin of the artery during catheter angiography procedures, individual evaluation of patients taking into account gender and age is of utmost importance.
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Affiliation(s)
- Necmi Keskin
- Department of Anatomy, Kocaeli University, Kocaeli, Türkiye, Turkey
| | - Belgin Bamac
- Department of Anatomy, Kocaeli University, Kocaeli, Türkiye, Turkey
| | - Ozgur Cakir
- Department of Radiology, Kocaeli University, Kocaeli, Türkiye, Turkey
| | - Tuncay Colak
- Department of Anatomy, Kocaeli University, Kocaeli, Türkiye, Turkey
| | - Cagatay Barut
- Department of Anatomy, School of Medicine, Istanbul Medeniyet University, Istanbul, Türkiye, 34715, Turkey.
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Dumlao KJP, Villacorta PRF, Mejia OAD. Anatomical Variations of the Celiac Trunk in Adult Filipino Cadavers: A Retrospective Study. ACTA MEDICA PHILIPPINA 2023; 57:61-65. [PMID: 39429762 PMCID: PMC11484559 DOI: 10.47895/amp.vi0.6814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/22/2024]
Abstract
Objective The celiac trunk (CT) is the first major branch of the abdominal aorta and typically gives rise to the left gastric artery (LGA), common hepatic artery (CHA), and splenic artery (SA), which supply blood to the abdominal viscera. Variations in the branching pattern of the CT exist and knowledge of such is crucial when performing surgical, laparoscopic, and angiographic procedures. The aim of this study is to determine the anatomic variations of the CT in adult Filipino cadavers and to compare the proportions of these with those reported in the foreign literature. Methods Adult Filipino cadavers from the University of the Philippines College of Medicine Anatomy Laboratory were dissected by first year medical students from 2014-2019. The CT and its branches were identified, drawn on a separate piece of paper, and confirmed to be correct and accurate by an anatomist. The data collected from that period was reviewed. Percentages were calculated for the branching patterns identified. A Z-test of Two Populations was used to compare the results of the current study to that of Pinal-Garcia (2018), Pillay (2020) and Venieratos (2013). Results A total of 107 drawings based on 107 dissected preserved cadavers were reviewed. Ninety-two specimens (85.98%) showed typical branching into the LGA, CHA, and SA. The CT presented as a true tripod (tripus Halleri) in 75 specimens (70.09%) and as a bifurcation with one of the three arteries arising first along the trunk (false tripod) in 17 specimens (15.89%). Nine cadavers (8.41%) showed additional branches arising from the CT and four (3.74%) showed bifurcation of the CT with the third branch arising from a different artery. Conclusion The most common configuration of the CT among Filipino adult cadavers is a true tripod, followed by a false tripod, additional branching, and bifurcation of the CT with the third branch arising elsewhere. The present study most closely resembles the results of the study of Venieratos.
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Affiliation(s)
- Karen June P. Dumlao
- Department of Anatomy, College of Medicine, University of the Philippines Manila, Philippines
| | | | - Olivia Agnes D. Mejia
- Department of Anatomy, College of Medicine, University of the Philippines Manila, Philippines
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18
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Lendoire M, Maki H, Haddad A, Jain AJ, Vauthey JN. Liver Anatomy 2.0 Quiz: Test Your Knowledge. J Gastrointest Surg 2023; 27:3045-3068. [PMID: 37803180 DOI: 10.1007/s11605-023-05778-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/01/2023] [Indexed: 10/08/2023]
Abstract
The liver is one the largest organs in the abdomen and the most frequent site of metastases for gastrointestinal tumors. Surgery on this complex and highly vascularized organ can be associated with high morbidity even in experienced hands. A thorough understanding of liver anatomy is key to approaching liver surgery with confidence and preventing complications. The aim of this quiz is to provide an active learning tool for a comprehensive understanding of liver anatomy and its integration into clinical practice.
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Affiliation(s)
- Mateo Lendoire
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Harufumi Maki
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Antony Haddad
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Anish J Jain
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA.
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19
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Khorobrykh T, Ivashov I, Spartak A, Reiter V, Grachalov A, Pronina P. A rare clinical case of hepatic artery anatomy in a patient with Siewert III cardioesophageal junction cancer: A case report. Int J Surg Case Rep 2023; 113:108997. [PMID: 37952491 PMCID: PMC10681911 DOI: 10.1016/j.ijscr.2023.108997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/13/2023] [Accepted: 10/21/2023] [Indexed: 11/14/2023] Open
Abstract
INTRODUCTION The normal anatomy of the celiac trunk (CT) is characterized by splitting into three branches in approximately 80 % of cases. In other cases, multiple anatomical variations can be observed. The purpose of this study was to review the clinical case featuring an extremely rare location of common hepatic artery (CHA) and to emphasize the importance of being familiar with possible anatomical variations of the hepatic artery through preoperative imaging in preparation for oncological surgery. PRESENTATION OF CASE A 71-year-old patient presented with Siewert III cardioesophageal junction cancer with liver metastases (T2N2M1, stage IV). Preoperative contrast-enhanced computed tomography (CECT) showed that the CHA branched from the AA. The operation included the proximal resection of the stomach and abdominal esophagus, D2 lymph nodes dissection, peritumoral liver resection, and extramucosal pyloroplasty. DISCUSSION We report a rare anatomical variation of replaced common hepatic artery, when it is located as VI type of Hiatt's classification - CHA branching from abdominal aorta (AA). It was discovered during contrast-enhanced computed tomography and illustrated by 3D reconstruction of vascular architectonics of the celiac trunk. CONCLUSION This case shows the importance of preoperative preparation using CECT to identify anatomical variations of the CHA, particularly for patients with locally advanced and metastatic cancer.
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Affiliation(s)
- Tatyana Khorobrykh
- Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University (Sechenov University), Dovator Street 15, Moscow 119048, Russia
| | - Ivan Ivashov
- Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University (Sechenov University), Dovator Street 15, Moscow 119048, Russia.
| | - Alexey Spartak
- Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University (Sechenov University), Dovator Street 15, Moscow 119048, Russia
| | - Victoriia Reiter
- Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University (Sechenov University), Dovator Street 15, Moscow 119048, Russia
| | - Anton Grachalov
- Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University (Sechenov University), Dovator Street 15, Moscow 119048, Russia
| | - Polina Pronina
- Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University (Sechenov University), Dovator Street 15, Moscow 119048, Russia
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20
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Chau P, Yoon JS, Moses D, Pather N. A systematic review and meta-analysis of portal vein morphometry in pediatric and adult populations: Drawing the line between normal and abnormal findings. Eur J Radiol 2023; 168:111016. [PMID: 37742371 DOI: 10.1016/j.ejrad.2023.111016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 07/13/2023] [Accepted: 07/26/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE The morphometry of the hepatic portal vein is of clinical importance, particularly in pre-operative assessments, surgical management, and diagnoses of liver conditions. This systematic review and meta-analysis aimed to characterize the morphometry of the normal portal vein in both pediatric and adult patients. METHODS The study, conducted using the PRISMA guidelines and registered with PROSPERO, utilized the MEDLINE, EMBASE, SCOPUS and Web of Science databases up to May 2020, and updated to May 2023. All studies reporting extractable data on diameter, length, and cross-sectional area (CSA) of the main, left, and right portal veins (PV, LPV, RPV, respectively) were included. The AQUA Tool was used to assess the quality of the included studies. Data analysis included subgroup analyses based on geographical location, sex, age, and imaging modality. RESULTS A total of 122 studies with 11,637 subjects were eligible for inclusion. Overall, the pooled mean diameter of the PV (PVD) was 10.09 mm (95% CI: 9.56-10.62). Significant differences in diameter were found between pediatric (6.60 mm; 95% CI: 5.38-7.82) and adult (10.72 mm; 95% CI: 10.25-11.19) subjects. Additionally, there was a significantly larger PVD measurement from computed tomography (CT) than other imaging modalities: CT, 13.28 mm (95% CI: 11.71-14.84); magnetic resonance imaging (MRI), 10.50 mm (95% CI: 9.35-11.66) and ultrasound (US), 9.81 mm (95% CI: 9.47-10.16). The mean diameters of the LPV and RPV were 8.27 mm (95% CI: 6.78-9.77) and 8.33 mm (95% CI: 6.70-9.95), respectively. Mean PV length in adults is 48.63 mm (95% CI: 35.63-61.64). Mean CSA of the PV was 1.09 cm2. CONCLUSIONS The study obtained aim to improve the understanding of portal vein anatomy, especially with relevance to surgical interventions of the liver in both pediatric and adult patients. Measurements from ultrasound imaging closely approximates the generated pooled PVD mean for pediatric and adult patients. CT imaging, however, significantly exceeded the established 13 mm threshold for adults. For pediatric patients, a threshold of 8 mm is proposed as a diagnostic upper limit for a normal PVD. Although not significant, the PVD decreased from the portal confluence towards its bifurcation.
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Affiliation(s)
- Patrick Chau
- Department of Anatomy, School of Biomedical Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Ji Soo Yoon
- Department of Anatomy, School of Biomedical Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Daniel Moses
- Department of Radiology, Prince of Wales Hospital, Sydney, Australia
| | - Nalini Pather
- Department of Anatomy, School of Biomedical Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia; Academy of Medical Education, Medical School, Faculty of Medicine, University of Queensland, Australia; Medical Education, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.
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21
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Frigerio I, Capelli G, Chiminazzo V, Spolverato G, Lorenzoni G, Mancini S, Giardino A, Regi P, Girelli R, Butturini G. Hepatic Artery Anomalies in Pancreaticoduodenectomy: Outcomes from a High-Volume Center. Dig Surg 2023; 40:196-204. [PMID: 37699375 DOI: 10.1159/000533619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 07/20/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Hepatic artery anomalies (HAA) may have an impact on surgical and oncological outcomes of patients undergoing pancreaticoduodenectomy (PD). METHODS Patients who underwent PD at our institution between July 2015 and January 2020 were retrospectively reviewed and classified into two groups: group 1, with presence of HAA, and group 2, with no HAA. A weighted logistic regression model was employed to assess the association between HAA and postoperative complications, and to assess the association between HAA and R status in patients with pancreatic cancer. RESULTS 502 patients were considered for analysis, with 75 (15%) of them in group 1. They had either an accessory (n = 28, 40.8%) or replaced (n = 26, 36.6%) right hepatic artery. Most patients underwent surgery for a malignancy (n = 451; 90%); among them, vascular resection was performed in 69 cases (15%). The presence of a HAA was reported at preoperative imaging only in 4 cases (5%) and the aberrant vessel was preserved in 72% of patients. At weighted multivariable logistic regression analysis, HAA were not associated to higher odds of morbidity (odds ratio [OR]: 0.753, 95% confidence interval [CI]: 0.543-1.043) nor to R1 status in case of pancreatic cancer (OR: 1.583, 95% CI: 0.979-2.561). CONCLUSION At our institution, the presence of HAA does not have an impact on postoperative outcomes or affects oncological clearance after PD. Hospitals', surgeons', volume and systematic review of preoperative imaging are all factors that help reduce possible adverse events.
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Affiliation(s)
- Isabella Frigerio
- Pancreatic Surgical Unit, Pederzoli Hospital, Peschiera del Garda, Italy,
| | - Giulia Capelli
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy
- Department of Surgery, ASST Bergamo Est, Seriate, Italy
| | - Valentina Chiminazzo
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Gaya Spolverato
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Silvia Mancini
- Department of General Surgery, Madonna della Navicella Hospital, Venice, Italy
| | | | - Paolo Regi
- Pancreatic Surgical Unit, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Roberto Girelli
- Pancreatic Surgical Unit, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Giovanni Butturini
- Pancreatic Surgical Unit, Pederzoli Hospital, Peschiera del Garda, Italy
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22
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Krishna PS, Soori A, Kalayarasan R, Biju P. Replaced Segment 6 Artery From the Gastroduodenal Artery: A Challenging and Rare Anatomical Variation of Hepatic Artery in Pancreaticoduodenectomy. Cureus 2023; 15:e44605. [PMID: 37795068 PMCID: PMC10546952 DOI: 10.7759/cureus.44605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/06/2023] Open
Abstract
Variations in the hepatic artery's anatomy can significantly impact planning and executing pancreatic and hepatobiliary surgeries. Of these, the commonest are variations of right and left hepatic arteries originating from superior mesenteric and left gastric arteries, respectively. The anomalous origin of the right hepatic artery from the gastroduodenal artery (GDA) is among the rarest and most challenging anatomy, especially in patients undergoing pancreatoduodenectomy (PD) since GDA ligation is a mandatory step, which may threaten the liver blood supply. We present a 62-year-old male with suspected distal cholangiocarcinoma and plan a robot-assisted pancreatoduodenectomy. Preoperative computed tomography evaluation revealed an anomalous segment 6 artery arising from the GDA and coursing posterolaterally to the common bile duct in the hepatoduodenal ligament. Also, the patient had a replacement left hepatic artery originating from the left gastric artery. The described vascular anomaly has not been previously reported in patients undergoing PD. Awareness of vascular anomalies is the key to performing oncologically radical surgery without increasing bleeding and ischemic complications in patients undergoing complex procedures like PD.
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Affiliation(s)
- Pothugunta S Krishna
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Abhijna Soori
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Raja Kalayarasan
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
| | - Pottakkat Biju
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, IND
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23
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Khalid A, Saleem MA, Ihsan-Ul-Haq, Khan Y, Rashid S, Dar FS. Anatomical variations in living donors for liver transplantation-prevalence and relationship. Langenbecks Arch Surg 2023; 408:323. [PMID: 37597008 DOI: 10.1007/s00423-023-03066-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/14/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE Living donor liver transplantation (LDLT) is a widely accepted option to address the lack of a deceased liver program for transplantation. Understanding vascular and biliary anatomy and their variants is crucial for successful and safe graft harvesting. Anatomic variations are common, particularly in the right hepatic lobe. To provide evidence for screening potential liver transplant donors, the presence of vascular and biliary anatomic variations in Pakistan's preoperative assessment of transplantation donor candidates was explored. METHODS This retrospective cross-sectional study evaluated the hepatic artery, portal vein, hepatic vein, and biliary variations in living liver donors. The study included 400 living liver donors; data were collected from March 2019 to March 2023. We used a CT scan and MRCP to assess the anatomical variations. RESULTS The study examined 400 liver donors aged 18 to 53 years. Conventional arterial anatomy was the most common (65.8%), followed by replaced right hepatic artery (16%) and replaced left hepatic artery (10.8%). Conventional type 1 biliary anatomy was seen in 65.8% of cases. The dominant right hepatic vein was found in 13.3% of donors. There was a significant association between the prevalence of variant portal venous anatomy with variant biliary anatomy. CONCLUSION Variations of the hepatic arterial, portal venous, and biliary systems are frequent and should be carefully evaluated while selecting a suitable living donor. A strong relationship between variant portal venous and biliary anatomy was found. These findings can aid in selecting suitable candidates and improving surgical planning for liver transplantation.
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Affiliation(s)
- Abdullah Khalid
- Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan.
| | - M Asad Saleem
- Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
| | - Ihsan-Ul-Haq
- Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
| | - Yasir Khan
- Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
| | - Sohail Rashid
- Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
| | - Faisal Saud Dar
- Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
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24
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Türkyılmaz Z, Kula O, Çelik AO, Demirel T, Günay B. Evaluation of celiac artery and common hepatic artery variations by CT-angiography and new classification model. Surg Radiol Anat 2023:10.1007/s00276-023-03180-1. [PMID: 37340150 DOI: 10.1007/s00276-023-03180-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/31/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE Knowledge of anatomical variations is important in all interventional procedures. This study aims to evaluate the variations and prevalence of celiac trunk (CeT) and its branches. METHODS The computerized tomography-angiography (CT-A) findings of 941 adult patients were evaluated retrospectively. Variations of the CeT and common hepatic artery (CHA) were evaluated according to the number of branches and their origin. Findings were compared with classical classification methods. A new classification model has been defined. RESULTS Normal (complete) trifurcation was detected in 856 (90.9%) of them, where left gastric artery (LGA), splenic artery (SpA) and CHA branches were derived from the CeT. Among 856 complete trifurcation cases, 773 (90.3%) had non-classical trifurcation patterns. The rate of classic trifurcation was 8.8%, while non-classic trifurcation was 82.1% in all cases. In one case (0.1%), LGA and left hepatic artery together and right hepatic artery and SpA together appeared as a double bifurcation. Complete celiacomesenteric trunk was observed only in 4 (0.42%) cases. In seven cases (0.7%), LGA, SpA and CHA were coming out of abdominal aorta (AAo) independently. CHA normal anatomy (Michels Type I) was detected in 618 (65.5%) patients. We found that 49 (5.2%) of our cases were ambiguous according to the Michels Classification. We have described five different variations of hepatic arteries directly arising from the AAo. CONCLUSION Preoperative recognition of anatomical variations of CeT, superior mesenteric artery and CHA is of primary importance in both surgical and radiological procedures. With careful evaluation of CT-angiographies, it is possible to detect rare variations.
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Affiliation(s)
- Zeliha Türkyılmaz
- Department of General Surgery, Trakya University Medical Faculty, 22030, Edirne, Turkey.
| | - Osman Kula
- Department of Radiology, Trakya University Medical Faculty, 22030, Edirne, Turkey
| | - Ahmet Onur Çelik
- Department of Radiology, Trakya University Medical Faculty, 22030, Edirne, Turkey
| | - Tuğrul Demirel
- Department of General Surgery, Trakya University Medical Faculty, 22030, Edirne, Turkey
| | - Burak Günay
- Department of Radiology, Trakya University Medical Faculty, 22030, Edirne, Turkey
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25
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Zhang R, Zhang HZ, Han T, Wei ZG, Shi ZY, Xu J. Effect of accessory hepatic artery reconstruction on prognosis in orthotopic liver transplantation: a single center experience. BMC Surg 2023; 23:138. [PMID: 37208662 DOI: 10.1186/s12893-023-02021-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND In orthotopic liver transplantation (OLT), preserving an aberrant hepatic artery (AHA) can increase the number of arterial anastomoses and may lead to arterial-related complications. AHA includes accessory hepatic artery and replaced hepatic artery. Herein, the purpose of our research is to evaluate the requirement for accessory anastomosis in OLT. METHODS We retrospectively reviewed a total of 95 patients who underwent OLT in our hospital between April 2020 and December 2022. We found seven cases of donor livers with accessory HA. The method of arterial anastomosis and details of the diagnosis and treatment of complications were collated. RESULTS Among 95 consecutive patients with OLT, complications occurred in two of seven patients-patient 2 had an accessory right hepatic artery, while patient 5 had an accessory left hepatic artery. Patient 2 showed bile leakage leading to rupture and bleeding of the accessory HA anastomosis after OLT, and was treated with interventional coil embolization. In patient 5, hepatic artery thrombosis and accessory HA occlusion were treated with embolization and thrombolysis of the splenic artery and left gastric artery. During the intervention, we also found that the internal hepatic artery and accessory HA had communicating branches. After treatment, both patients remain healthy with no complications such as liver necrosis or liver abscess. CONCLUSION An AHA can be ligated when assessed as an accessory artery. This can reduce the incidence of arterial complications, contribute to the perioperative management of liver transplantation (LT) patients, and improve the prognosis of LT.
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Affiliation(s)
- Rui Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Liver Transplantation Center, The First Hospital of Shanxi Medical University, No. 56 Xinjian South Road, Shanxi Province, 030001, Taiyuan, China
| | - He-Zhao Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Liver Transplantation Center, The First Hospital of Shanxi Medical University, No. 56 Xinjian South Road, Shanxi Province, 030001, Taiyuan, China
| | - Tian Han
- Department of Hepatobiliary and Pancreatic Surgery, Liver Transplantation Center, The First Hospital of Shanxi Medical University, No. 56 Xinjian South Road, Shanxi Province, 030001, Taiyuan, China
| | - Zhi-Gang Wei
- Department of Hepatobiliary and Pancreatic Surgery, Liver Transplantation Center, The First Hospital of Shanxi Medical University, No. 56 Xinjian South Road, Shanxi Province, 030001, Taiyuan, China
| | - Zhi-Yong Shi
- Department of Hepatobiliary and Pancreatic Surgery, Liver Transplantation Center, The First Hospital of Shanxi Medical University, No. 56 Xinjian South Road, Shanxi Province, 030001, Taiyuan, China
| | - Jun Xu
- Department of Hepatobiliary and Pancreatic Surgery, Liver Transplantation Center, The First Hospital of Shanxi Medical University, No. 56 Xinjian South Road, Shanxi Province, 030001, Taiyuan, China.
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26
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Bolintineanu Ghenciu LA, Bolintineanu SL, Iacob N, Zăhoi DE. Clinical Consideration of Anatomical Variations in the Common Hepatic Arteries: An Analysis Using MDCT Angiography. Diagnostics (Basel) 2023; 13:diagnostics13091636. [PMID: 37175027 PMCID: PMC10178316 DOI: 10.3390/diagnostics13091636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/19/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023] Open
Abstract
PURPOSE The purpose of this study was to determine the prevalence of normal hepatic vascularization and variations in the common hepatic arteries using multidetector computer tomography angiography. These variants should be acknowledged before any surgery of the upper abdomen. The aim of our work was to analyze the variations in the hepatic arteries and their possible clinical and surgical implications. MATERIALS AND METHODS This study was carried out on 4192 patients who underwent 64-slice MDCT angiography, from August 2015 to December 2021. We used surface and volume-rendering techniques in order to post-process images of the vascular components in the desired area. RESULTS We highlighted 76 cases with replaced common hepatic arteries, which are characterized by the origin of the common hepatic artery trunk located outside the classical composition of the celiac trunk. We identified three levels of origin: the abdominal aorta, the superior mesenteric artery and the left gastric artery. We observed six different aspects of the morphological variability of the celiac trunk and the superior mesenteric artery. The trajectory of the artery trunk, between the aortic origin and the hepatic pedicle portion of the hepatic portal vein, is variable and we analyzed the pancreatic trajectory accordingly. CONCLUSIONS The prevalence of hepatic arterial variants found during this study was similar to that in other specialized studies. We came across variants that have not been described in the well-known classification of Michels and even described extremely rare variations. The study of abnormal hepatic vascularization plays an important role in the surgical planning of hepatic transplantation, liver and pancreatic resection and extrahepatic upper abdominal surgeries.
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Affiliation(s)
- Laura Andreea Bolintineanu Ghenciu
- Department of Functional Sciences, Victor Babeș University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
- Department of Anatomy and Embryology, Victor Babeș University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
| | - Sorin Lucian Bolintineanu
- Department of Anatomy and Embryology, Victor Babeș University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
| | - Nicoleta Iacob
- Department of Multidetector Computed Tomography and Magnetic Resonance Imaging, Neuromed Diagnostic Imaging Centre, 300218 Timisoara, Romania
| | - Delia-Elena Zăhoi
- Department of Anatomy and Embryology, Victor Babeș University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
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27
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Taso M, Aramendía-Vidaurreta V, Englund EK, Francis S, Franklin S, Madhuranthakam AJ, Martirosian P, Nayak KS, Qin Q, Shao X, Thomas DL, Zun Z, Fernández-Seara MA. Update on state-of-the-art for arterial spin labeling (ASL) human perfusion imaging outside of the brain. Magn Reson Med 2023; 89:1754-1776. [PMID: 36747380 DOI: 10.1002/mrm.29609] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 02/08/2023]
Abstract
This review article provides an overview of developments for arterial spin labeling (ASL) perfusion imaging in the body (i.e., outside of the brain). It is part of a series of review/recommendation papers from the International Society for Magnetic Resonance in Medicine (ISMRM) Perfusion Study Group. In this review, we focus on specific challenges and developments tailored for ASL in a variety of body locations. After presenting common challenges, organ-specific reviews of challenges and developments are presented, including kidneys, lungs, heart (myocardium), placenta, eye (retina), liver, pancreas, and muscle, which are regions that have seen the most developments outside of the brain. Summaries and recommendations of acquisition parameters (when appropriate) are provided for each organ. We then explore the possibilities for wider adoption of body ASL based on large standardization efforts, as well as the potential opportunities based on recent advances in high/low-field systems and machine-learning. This review seeks to provide an overview of the current state-of-the-art of ASL for applications in the body, highlighting ongoing challenges and solutions that aim to enable more widespread use of the technique in clinical practice.
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Affiliation(s)
- Manuel Taso
- Division of MRI Research, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Erin K Englund
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Susan Francis
- Sir Peter Mansfield Imaging Center, University of Nottingham, Nottingham, UK
| | - Suzanne Franklin
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Center for Image Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ananth J Madhuranthakam
- Department of Radiology, Advanced Imaging Research Center, and Biomedical Engineering, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Petros Martirosian
- Section on Experimental Radiology, Department of Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA
| | - Qin Qin
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Xingfeng Shao
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - David L Thomas
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Zungho Zun
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
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28
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Jia H, Xi Y, Yuan P, Guo W, Xiong J. Coil embolization of asymptomatic left gastric artery aneurysm: Case report and literature review. Catheter Cardiovasc Interv 2023; 101:907-910. [PMID: 36906808 DOI: 10.1002/ccd.30625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/05/2023] [Accepted: 02/27/2023] [Indexed: 03/13/2023]
Abstract
Patients with visceral artery aneurysms are rare, and the reported incidence of left gastric aneurysm (LGA) is only 4%. At present, although there is little knowledge about such disease, it is generally believed that appropriate treatment should be planned to prevent some dangerous aneurysms from rupturing. We introduced a case of 83-year-old patient with LGA who underwent endovascular aneurysm repair. The 6-month follow-up computed tomography angiography showed complete thrombosis in the aneurysm lumen. In addition, to insight the management strategy on LGAs deeply, a literature review concerning this entity published in recent 35 years was performed.
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Affiliation(s)
- Heyue Jia
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China.,Department of Emergency Surgery, The People's Hospital of Peking University, Beijing, China
| | - Yifu Xi
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Pengfei Yuan
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Wei Guo
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
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29
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Saldarriaga B, Larrotta O, Ballesteros L. Morphological characteristics of the left gastric, common hepatic and splenic arteries. A descriptive study in human cadaveric specimens. Rev Col Bras Cir 2023; 50:e20233403. [PMID: 36790227 PMCID: PMC10519692 DOI: 10.1590/0100-6991e-20233403-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/16/2022] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVE to evaluate the morphology of the branches of celiac trunk (CT), left gastric (LGA), common hepatic (CHA), and splenic (SA) arteries in cadaveric specimens from a sample of a Colombian population. METHODS descriptive cross-sectional study of 26 blocks from the abdominal upper segment of human cadavers who underwent forensic autopsies at the Instituto de Medicina Legal at Bucaramanga, Colombia. The vascular beds of the celiac trunk were, subsequently, perfused with a semi-synthetic resin. RESULTS the diameters of LGA, CHA, and SA were 3.6±0.8mm, 5,2±1.2mm, and 5.9±1.0mm, respectively. Statistically, LGA and SA were different (p=<0.001). SA followed a linear trajectory in 8 (31%) samples, slightly tortuous in 4 (15%), and tortuous in 14 (54%). The tortuosity index was 1.25±0.18. Of the branches of CHA, the proper hepatic artery (PHA) had 4.8±1.2mm in diameter and 18.8±9.1mm in length, whereas the gastroduodenal artery (GDdA) had 4.1±0.8mm. In 2 cases (7.7%), an accessory hepatic artery from the LGA was found to supply perfusion to the left hepatic lobe. Finally, in 2 cases (7.7%) the SA came independently from the abdominal aorta. CONCLUSION the observed emergence incidence of the CT branches from the same level as reported in the literature is lower. The characterization, along with their variants, of LGA, CHA, and SA must be considered in surgical procedures in the upper abdominal segment, to avoid iatrogenic complications.
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Affiliation(s)
- Bladimir Saldarriaga
- - Universidad Autónoma de Bucaramanga, Basic Science - Bucaramanga - Santander - Colômbia
- - Universidad Industrial de Santander, Basic Science - Bucaramanga - Santander - Colômbia
| | - Oscar Larrotta
- - Universidad Autónoma de Bucaramanga, Basic Science - Bucaramanga - Santander - Colômbia
- - Universidad Industrial de Santander, Basic Science - Bucaramanga - Santander - Colômbia
| | - Luis Ballesteros
- - Universidad Autónoma de Bucaramanga, Basic Science - Bucaramanga - Santander - Colômbia
- - Universidad Industrial de Santander, Basic Science - Bucaramanga - Santander - Colômbia
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Ruzzenente A, Alaimo L, Conci S, De Bellis M, Marchese A, Ciangherotti A, Campagnaro T, Guglielmi A. Hyper accuracy three-dimensional (HA3D™) technology for planning complex liver resections: a preliminary single center experience. Updates Surg 2023; 75:105-114. [PMID: 36006558 PMCID: PMC9834350 DOI: 10.1007/s13304-022-01365-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/17/2022] [Indexed: 01/16/2023]
Abstract
Three-dimensional visualization technology (3DVT) has been recently introduced to achieve a precise preoperative planning of liver surgery. The aim of this observational study was to assess the accuracy of 3DVT for complex liver resections. 3DVT with hyper accuracy three-dimensional (HA3D™) technology was introduced at our institution on February 2020. Anatomical characteristics were collected from two-dimensional imaging (2DI) and 3DVT, while intraoperative and postoperative outcomes were recorded prospectively. A total of 62 patients were enrolled into the study. 3DVT was able to study tumor extension and liver anatomy, identifying at least one vascular variation in 37 patients (59.7%). Future remnant liver volume (FRLV) was measured using 2DI and 3DVT. The paired samples t test assessed positive correlation between the two methods (p < 0.001). At least one vessel was suspected to be invaded by the tumor in 8 (15.7%) 2DI cases vs 16 (31.4%) 3DVT cases, respectively. During surgery, vascular invasion was detected in 17 patients (33.3%). A total of 73 surgical procedures were proposed basing on 2DI, including 2 alternatives for 16 patients. After 3DVT, the previously planned procedure was changed in 15 cases (29.4%), due to the clearer information provided. A total of 51 patients (82%) underwent surgery. The most frequent procedure was right hepatectomy (33.3%), followed by left hepatectomy (23.5%) and left trisectionectomy (13.7%). Vascular resection and reconstruction were performed in 10 patients (19.6%) and portal vein was resected in more than half of these cases (66.7%). 3DVT leads to a more detailed and tailored approach to complex liver surgery, improving surgeons' knowledge of liver anatomy and accuracy of liver resection.
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Affiliation(s)
- Andrea Ruzzenente
- Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy.
| | - Laura Alaimo
- Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy
| | - Simone Conci
- Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy
| | - Mario De Bellis
- Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy
| | - Andrea Marchese
- Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy
| | - Andrea Ciangherotti
- Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy
| | - Tommaso Campagnaro
- Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy
| | - Alfredo Guglielmi
- Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy
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SALDARRIAGA BLADIMIR, LARROTTA OSCAR, BALLESTEROS LUIS. Características morfológicas das artérias gástricas esquerda, hepática comum e esplênica. Um estudo descritivo em espécimes cadavéricos humanos. Rev Col Bras Cir 2023. [DOI: 10.1590/0100-6991e-20233403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
RESUMO Objetivo: avaliar a morfologia dos ramos das artérias do tronco celíaco (CT), gástrica esquerda (LGA), hepática comum (HC) e esplênica (SA) em espécimes cadavéricos de uma amostra de uma população colombiana. Métodos: estudo transversal descritivo de 26 blocos do segmento superior abdominal de cadáveres humanos submetidos a necropsias forenses no Instituto de Medicina Legal de Bucaramanga, Colômbia. Os leitos vasculares do tronco celíaco foram, posteriormente, perfundidos com resina semissintética. Resultados: os diâmetros de LGA, CHA e SA foram 3,6±0,8mm, 5,2±1,2mm e 5,9±1,0mm, respectivamente. Estatisticamente, LGA e SA foram diferentes (p=<0,001). A SA seguiu uma trajetória linear em 8 (31%) amostras, levemente tortuosa em 4 (15%) e tortuosa em 14 (54%). O índice de tortuosidade foi de 1,25±0,18. Dos ramos do ACS, a artéria hepática própria (APH) tinha 4,8±1,2mm de diâmetro e 18,8±9,1mm de comprimento, enquanto a artéria gastroduodenal (GDdA) tinha 4,1±0,8mm. Em 2 casos (7,7%), uma artéria hepática acessória do GIG foi encontrada para fornecer perfusão ao lobo hepático esquerdo. Finalmente, em 2 casos (7,7%) a SA veio independentemente da aorta abdominal. Conclusão: a incidência observada de emergência dos ramos de TC do mesmo nível relatado na literatura é menor. A caracterização, juntamente com suas variantes, de LGA, CHA e SA deve ser considerada em procedimentos cirúrgicos no segmento abdominal superior, para evitar complicações iatrogênicas.
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Affiliation(s)
- BLADIMIR SALDARRIAGA
- Universidad Autónoma de Bucaramanga, Colombia; Universidad Industrial de Santander, Colombia
| | - OSCAR LARROTTA
- Universidad Autónoma de Bucaramanga, Colombia; Universidad Industrial de Santander, Colombia
| | - LUIS BALLESTEROS
- Universidad Autónoma de Bucaramanga, Colombia; Universidad Industrial de Santander, Colombia
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Khuntikeo N, Pugkhem A, Srisuk T, Luvira V, Titapun A, Tipwaratorn T, Thanasukarn V, Klungboonkrong V, Wongwiwatchai J. Surgery. Recent Results Cancer Res 2023; 219:147-222. [PMID: 37660334 DOI: 10.1007/978-3-031-35166-2_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
This chapter provides a comprehensive background from basic to applied knowledge of surgical anatomy which is necessary for the surgical treatment of cholangiocarcinoma (CCA) patients. Significant advances that have been made in the surgical treatment of CCA were examined. For instance, in-depth details are provided for appropriate preoperative assessment and treatment to optimize patient status and to improve the outcome of surgical treatment(s). Comprehensive details are provided for the surgical techniques and outcomes of treatments for each type of CCA with clear illustrations and images. This chapter also describes the role of minimally invasive surgery and liver transplantation in CCA treatment.
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Affiliation(s)
- Narong Khuntikeo
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, 40002, Thailand.
| | - Ake Pugkhem
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Tharatip Srisuk
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Vor Luvira
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Attapol Titapun
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Theerawee Tipwaratorn
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Vasin Thanasukarn
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Vivian Klungboonkrong
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Jitraporn Wongwiwatchai
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
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Muacevic A, Adler JR, Funk S, Houser JJ, Markand S. Variations of the Cystohepatic Blood Supply in American Midwestern Donor Cadavers. Cureus 2022; 14:e32260. [PMID: 36620853 PMCID: PMC9815782 DOI: 10.7759/cureus.32260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/12/2022] Open
Abstract
Knowledge of right hepatic artery (RHA) and cystic artery (CA) variations is crucial for surgeons performing procedures on the hepatobiliary system, pancreas, and duodenum. Commonly, the RHA originates from the superior mesenteric artery (SMA), while the CA originates from the RHA and is found within the cystic triangle during laparoscopic cholecystectomies. Here we investigated variations in the origin and path of the RHA and CA in a sample of American midwestern cadavers (n = 18) from the Gift of Body Program at A.T. Still University's Kirksville College of Osteopathic Medicine. Portal triads and associated vessels were dissected to reveal the artery pathways. The origin, branching pattern, and course of the RHA and CA were documented, and descriptive measurements were taken. We describe four cases where the RHA originated from the anterolateral proximal SMA, traveled deep to the pancreatic neck, and had a slightly variable but close relationship with the portal triad structures. The CA was present in the cystic triangle in all 18 donors, typically originating from the RHA except for one case where it originated from the left hepatic artery. In six cases, the CA originated outside of the cystic triangle, crossing either superficially or deeply to the common hepatic duct to enter the cystic triangle. Knowledge of these variations will enhance preoperative planning and the overall safety of surgical procedures in this area.
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Al Hinai M, Al Kindi I, Stephen E, Al Sukaiti R, Al Ajmi E, Al Wahaibi KN. Anatomical variations of hepatic arterial supply: a double whammy from Oman. ANZ J Surg 2022; 92:3391-3394. [PMID: 35451167 DOI: 10.1111/ans.17729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Meerah Al Hinai
- Vascular Surgery Unit, Department of Surgery, Sultan Qaboos University Hospital, Al-Khoud, Muscat, Oman
| | - Ibrahim Al Kindi
- Vascular Surgery Unit, Department of Surgery, Sultan Qaboos University Hospital, Al-Khoud, Muscat, Oman
| | - Edwin Stephen
- Vascular Surgery Unit, Department of Surgery, Sultan Qaboos University Hospital, Al-Khoud, Muscat, Oman
| | - Rashid Al Sukaiti
- Intervention Radiology, Department of Radiology, Sultan Qaboos University Hospital, Al-Khoud, Muscat, Oman
| | - Eiman Al Ajmi
- Department of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Al-Khoud, Muscat, Oman
| | - Khalifa Nasser Al Wahaibi
- Vascular Surgery Unit, Department of Surgery, Sultan Qaboos University Hospital, Al-Khoud, Muscat, Oman
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Muacevic A, Adler JR. Strategies in the Management of Pancreatic Ductal Adenocarcinoma Involving Aberrant Right Hepatic Artery Arising From the Superior Mesenteric Artery. Cureus 2022; 14:e30781. [PMID: 36320800 PMCID: PMC9614057 DOI: 10.7759/cureus.30781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction The prevailing guidelines do not include the involvement of an aberrant right hepatic artery (aRHA) arising from the superior mesenteric artery in classifying borderline resectable pancreatic ductal adenocarcinoma (BR PDAC). Our novel classification aims to distinguish different entities depending on the location and degree of tumor involvement of aRHA and propose a strategy to manage tumor involvement of aRHA in PDAC. Material and methods The patients who underwent pancreaticoduodenectomy (PD) from September 1, 2018, to August 31, 2022 were analyzed retrospectively, and patients with aRHA were included in the study. Depending on the radiological data, arterial involvement of the aRHA was classified into group I with proximal involvement of the aRHA up to 2 cm from its origin in the superior mesenteric artery (SMA) and group II with distal involvement of aRHA beyond 2 cm from its origin in SMA. In addition, the resection margin status was correlated with the technique employed for managing the tumor-involved artery. Results A total of 122 patients underwent PD during the study period. Eight patients were identified to have tumor involvement of the aRHA arising from the SMA. Among the five patients in group I, three patients who had upfront surgery showed R1 resection regardless of periarterial divestment or resection/reconstruction of the involved artery, whereas R0 resection was achieved in the two patients who had neoadjuvant therapy. All patients in group II had R0 resection regardless of receiving neoadjuvant therapy. There were no significant morbidity and mortality in our series. Conclusion The aRHA should be considered in the classification of BR PDAC. Management strategies should be tailored based on the location and the degree of tumor involvement in the aRHA. We advocate neoadjuvant therapy for proximal involvement and upfront surgery for distal involvement of aRHA to achieve good oncological clearance.
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Vas D, Moreno Rojas J, Solà Garcia M. Replaced right hepatic artery arising from the distal renal artery, a new variation. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:1339-1342. [PMID: 36097082 DOI: 10.1007/s00276-022-03017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Arterial irrigation of the liver is highly variable and widely studied due to its importance in the correct planification of the surgical or endovascular treatment of the hepatobilary area. Various classifications have been published of the common and uncommon anatomic variations of the hepatic arterial distribution. While the classic anatomic pattern of the proper hepatic artery-when it originates from the celiac trunk dividing into left and right branches-represents 50-83% of the described patterns, there are numerous uncommon distributions based on the presence of replaced or accessory hepatic arteries. In this article, we present a case of a replaced right hepatic artery originating from the right distal renal artery. METHODS Contrast enhanced computed tomography (CECT) examination was performed on a 67 years-old male patient with compensated alcoholic cirrhosis as part of the disease monitoring. RESULTS The replaced right hepatic artery of the patient arises from the right distal renal artery and-after its cranial course-enters the porta hepatis posterior to the main portal vein. After giving off the cystic artery, it irrigates the right hepatic lobe. The left hepatic artery does not show any variation. CONCLUSION We present CT angiography images of an extremely rare anatomic variation of the hepatic arterial irrigation in a cirrhotic patient.
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Affiliation(s)
- Daniel Vas
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain.
| | | | - Marta Solà Garcia
- Department of Radiology, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain
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Umugwaneza N, Byiringiro F, Ndahimana P, Ivang A, Nyundo M, Ntirenganya F, Gashegu J. Unusual anatomical variations of the hepatic arteries and bile ducts: What are the surgical implications. Afr Health Sci 2022; 22:697-702. [PMID: 36910391 PMCID: PMC9993316 DOI: 10.4314/ahs.v22i3.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction The knowledge of anatomy is essential for surgical safety and impacts positively on patients' outcomes. Surgeons operating on the liver and bile ducts should keep in mind the normal anatomy and its variations as the latter are common. Case Presentation We conducted a structured surgical dissection course of the supra-colic compartment of the abdominal cavity on 2nd and 3rd October 2020. While dissecting a 46years-old male cadaver, we encountered unusual anatomical variations of the hepatic arterial branching, the biliary tree, and arterial supply to the common bile duct. The common hepatic artery was dividing into two branches: a common short trunk for the left hepatic artery and the right gastric artery (hepato-gastric trunk) and a common trunk for the right hepatic artery and gastroduodenal artery (hepato-gastroduodenal trunk). The right hepatic duct was duplicated with a main right hepatic duct and an additional smaller duct. The bile duct was supplied by an artery coming from the abdominal aorta. Conclusion We described three unusual anatomical variations: a variation of the hepatic arteries branching pattern, an aberrant right hepatic duct, and blood supply to the bile duct from the abdominal aorta. Surgeons should be aware of these rare variations.
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Sukumaran TT, Joseph S, Ramakrishnan S, Mathew AJ. Anatomical variations of the hepatic artery in it's extra hepatic journey: a cadaveric study with its clinical implications. Anat Cell Biol 2022; 55:269-276. [PMID: 36002438 PMCID: PMC9519758 DOI: 10.5115/acb.22.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/30/2022] [Accepted: 04/12/2022] [Indexed: 11/27/2022] Open
Abstract
Vascular anomalies are a serendipitous finding during surgeries and diagnostic angiography. Such variations are frequently encountered in the abdominal region. These anomalies are usually asymptomatic but the presence of hepatic arterial variations may lead to injuries of the liver during surgery. The present study was conducted on 35 adult embalmed cadavers, 31 males, 4 females from August 2015 to December 2021 in the Department of Anatomy, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi. In this study of 35 cadavers, we present 3 variants: an accessory right hepatic artery, replaced common hepatic artery, replaced common hepatic artery anastomosis with accessory left hepatic artery and an arc of Buhler. One of our variants has not yielded a precedent in literature search. We have compared these variants with Michels and Hiatt classification. It is known that different variants arise at distinct stages of embryonic development. As specialists in anatomy, we have tried to correlate the variants in our study with their embryological origins.
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Affiliation(s)
- Tintu Thottiyil Sukumaran
- Department of Anatomy, Amrita School of Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Susan Joseph
- Department of Anatomy, Amrita School of Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Swapna Ramakrishnan
- Department of Anatomy, Amrita School of Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Asha Joselet Mathew
- Department of Anatomy, Amrita School of Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Frost JP, Bell J, Lawrance J, Najran P, Mullan D. Ambulatory Same-Day Map-and-Treat Angiography for Selective Internal Radiation Therapy Using a Transradial Approach. Cureus 2022; 14:e27741. [PMID: 36106229 PMCID: PMC9446378 DOI: 10.7759/cureus.27741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/26/2022] Open
Abstract
Historically, selective internal radiation therapy (SIRT) with yttrium-90 (Y-90) requires a two-week interval between workup and treatment (map and treat). The intervening gap between workup and treatment is used to plan for the dose required and obtain delivery of the radioactive Y-90. During the coronavirus disease 2019 pandemic, the delivery of a robust SIRT service was challenging due to unprecedented demands on all hospital services. Emergent practice changes were required to ensure this service could still be delivered to patients while retaining sufficient inpatient hospital beds and services for acutely unwell patients. In response to this, the interventional radiology team proposed the retention of a full SIRT service by removing the historical two-week interval between map and treat, delivering both components of the SIRT procedure on the same day. A traditional approach using femoral access would require a prolonged period of immobility and potentially an overnight stay. By adopting a transradial approach without sedo-analgesia, an ambulatory day-case map and treat SIRT with no post-procedure immobilisation was performed. This case report demonstrates the technical feasibility of same-day ‘map-and-treat’ SIRT, highlighting a paradigm shift from the conventional femoral access method and immobilisation to an ‘ambulatory’ approach with immediate mobilisation post-procedure.
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Yan Y, Wang B, Yuan W, Zhang J, Xiao J, Sha Y. A rare case with multiple arterial variations of the liver complicated laparoscopic pancreaticoduodenectomy. BMC Gastroenterol 2022; 22:331. [PMID: 35799108 PMCID: PMC9260989 DOI: 10.1186/s12876-022-02398-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Hepatic arterial variations were fully elaborated in anatomical monographs. Here, we aimed to present a rare case with multiple arterial variations of the liver complicated laparoscopic pancreaticoduodenectomy. Case presentation We report a 67-year-old woman with a periampullary tumor underwent laparoscopic pancreaticoduodenectomy. Intraoperatively, the aberrant right hepatic artery derived from the gastroduodenal artery (GDA) was observed and had accidentally sacrificed due to untimely ligature of GDA. Three-dimensional reconstruction based on preoperative contrast-enhanced CT performed to better study the anatomy. It demonstrated a replaced right hepatic artery branched from the GDA and supplied right liver lobe. Meanwhile, the middle hepatic artery derived from the common hepatic artery and supplied hepatic segment IV. Additionally, the replaced left hepatic artery emerged from the left gastric artery and fed into left liver lobe. Conclusions The origination and course of hepatic arterial anatomy should be thoroughly assessed in planning and performing hepatopancreatobiliary surgeries. Reconstruction images of contrast-enhanced CT are helpful to visualize the vascular variations and its spatial relation with adjacent structures.
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Affiliation(s)
- Yong Yan
- Department of General Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China.
| | - Bailin Wang
- Department of General Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
| | - Wei Yuan
- Department of General Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
| | - Jiansong Zhang
- The Medical College of Guizhou Medical University, Guiyang, 550025, China
| | - Junhao Xiao
- The Medical College of Guizhou Medical University, Guiyang, 550025, China
| | - Yanhua Sha
- Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
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Keshav N, Ohliger MA. Imaging Vascular Disorders of the Liver. Radiol Clin North Am 2022; 60:857-871. [PMID: 35989049 DOI: 10.1016/j.rcl.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Sheridan A, Reynolds E, Maynes E, Wind G, Leighton MX, Granite G. A Hepatogastrophrenic Trunk, Celiacomesenteric Trunk, and a Middle Mesenteric Artery in a 68-Year-Old White Male Donor. Diagnostics (Basel) 2022; 12:diagnostics12071597. [PMID: 35885503 PMCID: PMC9325176 DOI: 10.3390/diagnostics12071597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 11/18/2022] Open
Abstract
A detailed understanding of the enteric vascular supply is of great importance for pre-operative planning. In the case of this 68-year-old white male donor, the following variations were observed: a hepatogastrophrenic trunk, a celiacomesenteric trunk, and a middle mesenteric artery. Literature review was conducted to understand the frequency and clinical significance of these variations.
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Affiliation(s)
- Ariana Sheridan
- Directorate for Education, Training, and Research, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA;
| | - Elizabeth Reynolds
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA;
| | - Elizabeth Maynes
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (E.M.); (G.W.); (M.X.L.)
| | - Gary Wind
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (E.M.); (G.W.); (M.X.L.)
| | - Maria Ximena Leighton
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (E.M.); (G.W.); (M.X.L.)
| | - Guinevere Granite
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (E.M.); (G.W.); (M.X.L.)
- Correspondence: ; Tel.: +1-301-295-1500
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Isola D, Jawad ZAR, Chua E, Shorvon P, Martinez-Isla A. Traction-induced aneurysm of an accessory left hepatic artery: a potentially fatal but synchronously treatable complication of a large hiatus hernia. Ann R Coll Surg Engl 2022; 104:e174-e176. [PMID: 34982605 PMCID: PMC9157944 DOI: 10.1308/rcsann.2021.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 59-year-old man presented to our surgical clinic with a long-standing history of heart burn, and upper abdominal pain. Gastroscopy showed a large sliding hiatus hernia associated with severe reflux oesophagitis. Oesophageal pH manometry revealed a high DeMeester score of 36.03. A computed tomography (CT) scan was performed for preoperative hiatal hernia repair planning. This showed the incidental finding of an accessory left hepatic artery (ALHA) and an aneurysm of this accessory artery. The aneurysm occurred at the point where the ALHA traversed the diaphragmatic crus and was only present in association with the hiatus hernia. These observations suggest that the aetiology of the aneurysm was due to traction during development of the hiatus hernia. The patient went onto have a laparoscopic hiatus hernia repair and Toupet fundoplication with ligation of the accessory left hepatic artery and made an excellent recovery. ALHAs are not uncommon, occurring in around 15% of the general population, with aneurysms of the hepatic arteries accounting for about 20% of cases of visceral artery aneurysms. The case presented herein highlights the importance of performing an arterial phase CT when planning surgery for large hiatus hernias to detect more cases like this one. This would allow early detection and concurrent treatment of an associated aneurysm with repair of the hiatus hernia, to prevent aneurysmal complications later on.
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Affiliation(s)
- D Isola
- London North West University Healthcare NHS Trust, UK
| | - ZAR Jawad
- London North West University Healthcare NHS Trust, UK
| | - E Chua
- London North West University Healthcare NHS Trust, UK
| | - P Shorvon
- London North West University Healthcare NHS Trust, UK
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Xu YC, Yang F, Fu DL. Clinical significance of variant hepatic artery in pancreatic resection: A comprehensive review. World J Gastroenterol 2022; 28:2057-2075. [PMID: 35664036 PMCID: PMC9134138 DOI: 10.3748/wjg.v28.i19.2057] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/16/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
The anatomical structure of the pancreaticoduodenal region is complex and closely related to the surrounding vessels. A variant of the hepatic artery, which is not a rare finding during pancreatic surgery, is prone to intraoperative injury. Inadvertent injury to the hepatic artery may affect liver perfusion, resulting in necrosis, liver abscess, and even liver failure. The preoperative identification of hepatic artery variations, detailed planning of the surgical approach, careful intraoperative dissection, and proper management of the damaged artery are important for preventing hepatic hypoperfusion. Nevertheless, despite the potential risks, planned artery resection has become acceptable in carefully selected patients. Arterial reconstruction is sometimes essential to prevent postoperative ischemic complications and can be performed using various methods. The complexity of procedures such as pancreatectomy with en bloc celiac axis resection may be mitigated by the presence of an aberrant right hepatic artery or a common hepatic artery originating from the superior mesenteric artery. Here, we comprehensively reviewed the anatomical basis of hepatic artery variation, its incidence, and its effect on the surgical and oncological outcomes after pancreatic resection. In addition, we provide recommendations for the prevention and management of hepatic artery injury and liver hypoperfusion. Overall, the hepatic artery variant may not worsen surgical and oncological outcomes if it is accurately identified pre-operatively and appropriately managed intraoperatively.
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Affiliation(s)
- Ye-Cheng Xu
- Department of Pancreatic Surgery, Huashan Hospital, Shanghai 200040, China
| | - Feng Yang
- Department of Pancreatic Surgery, Huashan Hospital, Shanghai 200040, China
| | - De-Liang Fu
- Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai 200040, China
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Simonini R, Bonaffini PA, Porta M, Maino C, Carbone FS, Dulcetta L, Brambilla P, Marra P, Sironi S. Accuracy of Inflow Inversion Recovery (IFIR) for Upper Abdominal Arteries Evaluation: Comparison with Contrast-Enhanced MR and CTA. Diagnostics (Basel) 2022; 12:diagnostics12040825. [PMID: 35453873 PMCID: PMC9025362 DOI: 10.3390/diagnostics12040825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Inflow-sensitive inversion recovery (IFIR) is a recently introduced technique to perform unenhanced magnetic resonance angiography (MRA). The purpose of our study is to determine the accuracy of IFIR-MRA in the evaluation of upper abdominal arteries, compared to standard MRA and computed tomography angiography (CTA). Materials and Methods: Seventy patients undergoing upper abdomen Magnetic Resonance Imaging (MRI) in different clinical settings were enrolled. The MRI protocol included an IFIR-MRA sequence that was intra-individually compared by using a qualitative 4-point scale in the same patients who underwent concomitant or close MRA (n = 65) and/or CTA (n = 44). Celiac trunk (CA), common-proper-left-right hepatic artery (C-P-L-R-HA), left gastric artery (LGA), gastroduodenal artery (GDA), splenic artery (SA), renal arteries (RA) and superior mesenteric artery (SMA) were assessed. Results: IFIR-MRA images were better rated in comparison with MRA. Particularly, all arteries obtained a statistically significant higher qualitative rating value (all p < 0.05). IFIR-MRA and MRA exhibited acceptable intraclass correlation coefficients (ICC) values for CA, C-L-R-HA, and SMA (ICC 0.507, 0.591, 0.615, 0.570, 0.525). IFIR-MRA and CTA showed significant correlations in C-P-L-R-HA (τ = 0.362, 0.261, 0.308, 0.307, respectively; p < 0.05), and in RA (τ = 0.279, p < 0.05). Conclusions: Compared to MRA, IFIR-MRA demonstrated a higher image quality in the majority of upper abdomen arterial vessels assessment. LHA and RHA branches could be better visualized with IFIR sequences, when visualizable. Based on these findings, we suggest to routinely integrate IFIR sequences in upper abdomen MRI studies.
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Affiliation(s)
- Roberto Simonini
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (R.S.); (P.A.B.); (F.S.C.); (L.D.); (P.B.); (P.M.); (S.S.)
- School of Medicine, University Milano Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milano, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (R.S.); (P.A.B.); (F.S.C.); (L.D.); (P.B.); (P.M.); (S.S.)
- School of Medicine, University Milano Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milano, Italy
| | - Marco Porta
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (R.S.); (P.A.B.); (F.S.C.); (L.D.); (P.B.); (P.M.); (S.S.)
- School of Medicine, University Milano Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milano, Italy
- Correspondence: ; Tel.: +39-338-704-8845
| | - Cesare Maino
- Department of Radiology, San Gerardo Hospital, Via G. B. Pergolesi 33, 20900 Monza, Italy;
| | - Francesco Saverio Carbone
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (R.S.); (P.A.B.); (F.S.C.); (L.D.); (P.B.); (P.M.); (S.S.)
- School of Medicine, University Milano Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milano, Italy
| | - Ludovico Dulcetta
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (R.S.); (P.A.B.); (F.S.C.); (L.D.); (P.B.); (P.M.); (S.S.)
- School of Medicine, University Milano Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milano, Italy
| | - Paolo Brambilla
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (R.S.); (P.A.B.); (F.S.C.); (L.D.); (P.B.); (P.M.); (S.S.)
| | - Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (R.S.); (P.A.B.); (F.S.C.); (L.D.); (P.B.); (P.M.); (S.S.)
- School of Medicine, University Milano Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milano, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (R.S.); (P.A.B.); (F.S.C.); (L.D.); (P.B.); (P.M.); (S.S.)
- School of Medicine, University Milano Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milano, Italy
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Gao J, King J, Chatterji M, Miller BR, Siddoway RL. Superb Microvascular Imaging-Based Vascular Index to Assess Adult Hepatic Steatosis: A Feasibility Study. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:480-487. [PMID: 34872787 DOI: 10.1016/j.ultrasmedbio.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/28/2021] [Accepted: 11/01/2021] [Indexed: 06/13/2023]
Abstract
The aim of the study was to assess the feasibility of using a superb microvascular imaging-based vascular index (SMI-VI) for evaluating adult hepatic steatosis. We prospectively compared liver parenchyma SMI-VI (color pixels/total pixels in the region of interest), portal vein velocity, hepatic artery Doppler parameters (peak systolic velocity, end diastolic velocity, resistive index) and serum lipid and alanine aminotransferase (ALT) levels between 16 normal livers and 34 steatotic livers using magnetic resonance imaging-proton density fat fraction (MRI-PDFF) as the reference. On the basis of a two-tailed t-test, differences in SMI-VI, portal vein velocity, MRI-PDFF and ALT between normal (MRI-PDFF <5%) and steatotic (MRI-PDFF ≥5%) livers were statistically significant (p < 0.02), whereas hepatic artery Doppler parameters and triglyceride levels were not (p > 0.05). We observed an inverse correlation of SMI-VI with MRI-PDFF (r = -0.88). With 0.19 as the best cutoff value, the area under the receiver operating characteristic curve, sensitivity and specificity of SMI-VI for determining ≥mild (MRI-PDFF ≥5%) non-alcoholic fatty liver disease (NAFLD) were 0.95, 96% and 94%, respectively. Our results indicate the feasibility of using SMI-VI to assess adult hepatic steatosis. SMI-VI is a potential surrogate marker in the screening for NAFLD.
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Affiliation(s)
- Jing Gao
- Rocky Vista University, Ivins, Utah, USA; Department of Radiology, Weill Cornell Medicine, New York, New York, USA.
| | - Jacob King
- Rocky Vista University, Ivins, Utah, USA
| | - Manjil Chatterji
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
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Leclerc JF, Avila F, Hossu G, Felblinger J, Ayav A, Laurent V. Surgical anatomy of hepatic arteries from its origin to segmental branching: A 500 cases CT study. Am J Surg 2022; 224:506-513. [DOI: 10.1016/j.amjsurg.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/17/2022] [Accepted: 03/01/2022] [Indexed: 11/01/2022]
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Abstract
BACKGROUND Computed tomography (CT) is routinely used to determine the suitability of potential living donor liver transplants, providing important information about liver size, vascular anatomy, and the presence of other diseases that would preclude it from safe donation. CT is not routinely used, however, when evaluating eligible deceased organ donors after brain death, a group which comprises most orthotopic liver transplants. After the installation of a CT scanner at a local procurement facility, CTs have been performed on potential deceased organ donors and used, in conjunction with other evaluative protocols, to help direct donation decisions and assist in procurement procedures. STUDY DESIGN A retrospective analysis of data from 373 cases spanning 5 years was systematically collected and analyzed, including information pertaining to patient's medical histories, biopsy results, operative findings, and CT results. RESULTS CT findings directly impacted the directive decision-making process in 29% of cases in this patient cohort, likely an underestimate, and reliably evaluated important factors including variant vascular anatomy and the presence and severity of hepatic steatosis and cirrhosis. CONCLUSION Overall, this study suggests that CT has the potential to play a significant role in procurement procedures and the directive decision-making process, thereby improving the efficiency and accuracy by which potential deceased organ donors are evaluated.
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Sharbidre KG, Aziz MU, Mohd Z. Review of Abdominal Vascular Variations: Imaging and Clinical Implications. Radiographics 2022; 42:E27-E28. [PMID: 34990313 DOI: 10.1148/rg.210093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kedar G Sharbidre
- From the Section of Abdominal Imaging, Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N357, Birmingham, AL 35249
| | - Muhammad U Aziz
- From the Section of Abdominal Imaging, Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N357, Birmingham, AL 35249
| | - Zahid Mohd
- From the Section of Abdominal Imaging, Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JT N357, Birmingham, AL 35249
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Malviya KK, Verma A, Nayak AK, Mishra A, More RS. Unraveling Variations in Celiac Trunk and Hepatic Artery by CT Angiography to Aid in Surgeries of Upper Abdominal Region. Diagnostics (Basel) 2021; 11:2262. [PMID: 34943499 PMCID: PMC8700197 DOI: 10.3390/diagnostics11122262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/24/2021] [Accepted: 11/27/2021] [Indexed: 11/26/2022] Open
Abstract
Understanding of variations in the course and source of abdominal arteries is crucial for any surgical intervention in the peritoneal space. Intricate surgeries of the upper abdominal region, such as hepato-biliary, pancreatic, gastric and splenic surgeries, require precise knowledge of regular anatomy and different variations related to celiac trunk and hepatic artery. In addition, information about the origin of inferior phrenic artery is important in conditions such as hepatocellular carcinoma and gastroesophageal bleeding management. The present study gives an account of anatomical variations in origin and branching pattern of celiac trunk and hepatic artery by the use of CT (computed tomographic) angiography. The study was performed on 110 (66 females and 44 males) patients in a north Indian population. Results unraveled the most common celiac trunk variation as hepatosplenic trunk with left gastric artery, which was observed in 60% of cases, more common in females than in males. Gastrosplenic and hepato-gastric trunk could be seen in 4.55% and 1.82% cases respectively. Gastrosplenic trunk was more commonly found in females, whereas hepato-gastric trunk was more common in males. A gastrosplenic trunk, along with the hepato-mesenteric trunk, was observed in 1.82% cases and was more common in males. A celiacomesenteric trunk, in which the celiac trunk and superior mesenteric artery originated as a common trunk from the aorta, was seen only in 0.91% of cases, and exhibited an origin of right and left inferior phrenic artery from the left gastric artery. The most common variation of hepatic artery, in which the right hepatic artery was replaced and originated from the superior mesenteric artery, was observed in 3.64%, cases with a more common occurrence in males. In 1.82% cases, the left hepatic artery was replaced and originated from the left gastric artery, which was observed only in females. Common hepatic artery originated from the superior mesenteric artery, as observed in 1.82% cases, with slightly higher occurrence in males. These findings not only add to the existing knowledge apart from giving an overview of variations in north Indian population, but also give an account of their correlation with gender. The present study will prove to be important for various surgeries of the upper abdominal region.
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Affiliation(s)
- Kapil Kumar Malviya
- Department of Anatomy, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, India; (A.K.N.); (A.M.); (R.S.M.)
| | - Ashish Verma
- Department of Radiodiagnosis and Imaging, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, India;
| | - Amit Kumar Nayak
- Department of Anatomy, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, India; (A.K.N.); (A.M.); (R.S.M.)
| | - Anand Mishra
- Department of Anatomy, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, India; (A.K.N.); (A.M.); (R.S.M.)
| | - Raghunath Shahaji More
- Department of Anatomy, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, India; (A.K.N.); (A.M.); (R.S.M.)
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